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Deciding on Assisted Living

When your aging parent begins to seem frail, muddled, lonely, or less able to take care of herself, one of the main decisions you're going to face is whether to help her "age in place" and continue living in her home with the help of in-home care, or whether it would be a better idea for her to move into a senior care facility.

Aging in place, as senior care experts call it, is the first choice of the majority of older adults, but it may not always be the best, safest, or most cost-effective option. In fact, one of the many surprising discoveries that adult children often make is that as time goes on, in-home care can become as expensive -- or even more expensive -- than residential care in some circumstances. And, of course, cost is not the only factor to consider; there are many good reasons for older adults to remain in their homes, and many good reasons to move.

So how do you evaluate your aging parent's needs and compare the various options available? Here are some insights into the pros, cons, and costs of assisted living as compared with in-home care.

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Pros of Moving to Assisted Living

Flexibility to adapt to changing needs
Things can change quickly as an older adult's health declines, and many adult children are caught by surprise and find themselves playing catch-up as their parent's needs accelerate. "The very essence of aging is that it's degenerative," says Mary Kay Buysse, executive director of the American Association of Senior Move Managers. "So the way things are now is not how they're going to be. You can buy yourself some time, but eventually big decisions have to be made."

And you don't want to be making these decisions in a hurry, says Maria Basso Lipani, a licensed clinical social worker in New York who runs www.geriatriccaremanagement.com. "For adult children, it's like they are standing on the edge of a pool and they don't know it," says Lipani. "They're about to get shoved in, and they don't have a bathing suit or water shoes or a towel -- they're totally unprepared for what's to come." With the flexibility of multiple levels of care, assisted living offers you a variety of options so your family is not caught unprepared in a crisis.

Availability of expert assessment
"Is Mom really OK?" It's the most common question experts hear from adult children -- and one that's not easy to answer without careful assessment. Unfortunately, family members may have trouble getting an accurate picture of an older adult's true situation, especially if they are primarily seeing their loved one during short social visits. "You have to look for red flags such as not eating well, financial issues, or no longer being able to drive safely, " says Bunni Dybnis, a Los Angeles-based geriatric care manager and spokesperson for the
National Association of Professional Geriatric Care Managers.

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Even when you identify causes for concern, it's not easy for adult children to confront their parents about such private matters. "It's a huge change psychologically to try to take control when your parent was always the one taking care of you," says Dybnis. "There can be a great deal of fear about changing the family system." A professional evaluation, on the other hand, looks at how well your loved one is coping with the activities of daily living (ADLs), so you know how much care your parent really needs.

No need for home maintenance
Another thing families often forget to factor in, senior experts say, is the cost of maintaining the home. As people get older, often they can't do even routine household tasks, much less repairs, yard work, or serious cleaning.

Availability of full-time and 24-hour assistance
For many older adults, the riskiest times are in the evenings and at night, when falling danger is higher and someone with Alzheimer's or dementia may experience the behavior issues of sundown syndrome. In some situations, assisted living may be the most practical solution if your loved one needs someone with her overnight.

Access to government assistance benefits
If your loved one is eligible for financial assistance, such as Medicaid or veterans' benefits, moving to assisted living or a skilled nursing facility may offer access to significant financial benefits, some of which aren't available for home care. While some government benefits will pay for in-home care -- and in some cases will even pay a family caregiver to provide that care -- the application and approval process is quite complicated. Many assisted living communities have financial specialists who will help you with the application process -- or even do it for you -- which may result in your family member receiving more benefits.

Cons of Moving to Assisted Living

High cost of personal care
One thing many families don't realize is that most assisted living facilities don't include personal care in their basic fees but treat it as an add-on for an additional cost, says Dybnis. So while the facility's starting bill of $3,000 to $4,000 a month might seem reasonable, those costs can mount quickly as you add hours of care assistance.

Underestimating growing costs
Assisted living communities periodically reassess the needs of residents to determine whether they need more assistance, and as a result they may require a move to a higher, more expensive tier of care. If families aren't prepared for these rising costs, says Lipani, they may find they can no longer afford a living situation that they'd intended to be permanent.

Lack of or high cost for dementia care
Some assisted living facilities offer a dementia care option, but many do not. And in facilities that do provide specialized dementia care, there are typically steep charges.

Problems adjusting to group living
Many seniors want to stay in their homes, pure and simple, says Mary Kay Buysse of the American Association of Senior Move Managers. They are so strongly set against moving to assisted living that adjustment would be difficult. "They just want to be in their own bed, in their own house, and nothing is going to change their minds." In other cases, an older adult may have personality, behavior, or health issues that would make it difficult for them to assimilate to or be accepted into assisted living.

Cost Comparison for Assisted Living

For most adults, the most affordable option is to live independently, as long as they are able to care for themselves or can get by with family help or a few hours a day of paid help. But according to calculations by some senior care experts, once your loved one needs full-time daily care, and especially continuous 24-hour care, the cost comparison between aging in place with an in-home caregiver and moving to an assisted living facility or nursing home becomes more equivalent. This is especially true if you live in an area where in-home care costs are higher, such as in or near a big city or on either of the coasts.

"Depending where your parent lives, the cost for 12 hours per day of a home health aide and the cost of an assisted living facility may be about the same," says Lipani.

In urban areas, home care can easily run you at least $20 an hour, says Lipani, which adds up to $240 for a 12-hour day or $7,200 for a 30-day month. (Many adult children think of care on a 40-hour-a-week basis, forgetting about weekends and evenings, experts say.) Compare that with assisted living, which would cost somewhere between $4,000 and $8,000 a month, depending on the level of care your parent needs.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

I take care of my 90 year old mother, At home, I am 65 myself.
She has Alzheimer and vascular dementia for last 6 years.
If you are thinking of doing this home care yourself ,YOU MUST be ready for the work. The mental and physical demands can and ARE GREAT.
You can burn out FAST!! if you don't get the help YOU NEED.
I use Alzheimers support groups for the mental and work out
when she sleeps to keep up with the physical.
Also at 65 I know I may start to fail myself.
So make plans "WAY A HEAD" if you can do not put it off.
I live in western mass I,use a state program called.
""Western mass Eldercare"" This program does a few things.
They check eligibility for added insurance called ""Mass Health"".
This helps with all meds and if there Doctor writes a scrip such things.
Like Ensure drinks and incontinence care products as needed.
This program is for seniors needing long-term care also It checks there eligibility for nursing homes so that there is no delay when the time comes.
At 65 who knows I may have a stroke or heart attack at any time myself.
One phone call and she goes into a home the next day no delay.
This takes a lot off my mind knowing she will be cared for if I have a problem myself.
I also use a program called "Adult foster care" this is where you take
care of your mother or father your self at home till such time as there passing or they must go into a nursing home.
This program "pays you" for there care in "YOUR" home.
As if you are the nursing home your self the amount goes by how much
care they need on any given day this helps with extra things you my need.
There are a few rules, such as, you must have.
Smoke alarms, fire extinguishers, grab bars, first aid kits ECT...
It cost me about $100.00 for all the things I needed.
They also come in each month to check on the two of you to see how your doing.
And are a great help with any problems you are having as far as care.
One is a RN and the other is a case worker and are of great value at times for me and my mother they take the time to talk and give advice.
Plan a head, check for programs in your area and state.
And USE THEM!! they are there to help you.
And may GOD watch over you.
first aid kits
home
FOSTER CARE"

over 3 years ago,
LadyLew
said...

well presented info to pass on the my son who manages my finances, and wants to postpone my moving out of my home, whereas I am aware how much it will soon cost to just do the housework, shopping, meal prep and cleanup, and errands. Thank goodness I don't need personal help yet, but I may soon if for nothing more than picking me up off the floor when I fall down and can't get up on my own.

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